T形锁定板治疗掌侧Barton骨折疗效分析

目的 探讨T形锁定板内固定治疗掌侧Barton骨折的疗效。方法 对掌侧Barton骨折20例采用掌侧入路T形锁定板内固定治疗。结果 20例获得随访6-18个月,骨折均获愈合,腕关节功能按Sarmiento标准进行评定：优13例,良5例,可1例,差1例,优良率90%。结论 采用掌侧入路T形锁定板治疗掌侧Barton骨折,复位良好,腕关节功能术后恢复良好,可获得较好的临床疗效。     

掌侧Henry入路在桡骨干骨折手术治疗中的临床应用

[目的]探讨掌侧Henry入路的临床解剖学依据,论证其在桡骨干骨折手术应用中的优越性.[方法]自2006年12月～2009年6月,对71例桡骨干骨折患者行掌侧Henry入路A0重建钢板或"T"形钢板内固定术.男49例,女22例,年龄14～55岁,平均29岁.开放性损伤9例,闭合性损伤62例,其中桡骨干近段25例,中段21例,远段19例,中段和远段交界处6例.合并川侧尺骨干骨折56例,其余均为单纯桡骨干骨折.受伤至实施手术的时间为5 h～7d,平均3 d.[结果]本组患荇获得12～29个月(平均17个月)随访,均获骨性愈合.无感染、内固定失效及神经或血管损伤等并发症发生.肘和腕关节屈伸功能正常.前臂功能按Grace和Eversmann评定标准进行评定,优42例,良25例,可4例,优良率94.4%.[结论]掌侧Henry人路应用于桡骨干骨折手术,可有效果避开重要神经血管,切口体表定位和置放钢板便捷.掌握显露途径、解剖复位、牢固固定及术后积极功能锻炼是治疗成功的关键.     

掌侧型Barton骨折的手术治疗

目的介绍掌侧型Barton骨折的手术治疗。方法采用腕掌侧切口，直视下将骨折复位，应用AO-T型钢板内固定，无需外固定，早期功能锻炼。结果7例患者均获得6个月以上随访，无切口感染，平均骨愈合时间8周，功能评定优。结论掌侧型Barton骨折应用AO-T型钢板内固定是一种合理有效的方法，无需外固定，腕关节功能恢复好。     

掌侧锁定钢板治疗桡骨远端不稳定型骨折

目的探讨掌侧入路锁定钢板内固定治疗桡骨远端不稳定型骨折的临床疗效。方法对2006年8月至2011年12月我科收治的44例桡骨远端不稳定型骨折予以掌侧入路切开复位,以＂T＂形薄型桡骨远端锁定钢板内固定治疗。其中男19例,女25例;年龄21～69岁,平均54.4岁。根据桡骨远端骨折分型,B2型8例,B3型22例,C1型14例。结果 41例得到6～22个月随访,骨折全部愈合。根据Gartland和Werleg功能评分标准进行疗效评价,优35例,良4例,差2例,优良率95.1%。结论采用掌侧入路锁定钢板治疗桡骨远端不稳定型骨折,能有效维持骨折断端的复位,适应早期功能锻炼需要,疗效满意。     

掌侧斜T型钛板固定治疗严重移位Barton骨折

目的 探讨应用掌侧入路结合斜T型钛板固定治疗严重移位桡骨远端Barton骨折的疗效.方法 对11例严重移位桡骨远端Barton骨折,采用掌侧入路,腕关节面严格解剖复位后,行掌侧斜T型钛板固定.结果 术后随访6个月至3年,平均23.6个月,骨折均在术后3～4个月内愈合.根据腕关节功能评分标准(Gartland-Werley评分)评定:优8例,良2例,可1例;优良率为90.9%.按PRWE评分均在30分以内.结论 对严重移位桡骨远端Barton骨折,应采用手术方法治疗,经掌侧入路结合斜T型钛板固定治疗,可明显缩短治疗时间.     

掌侧入路异形钢板固定治疗Barton骨折

目的探讨经掌侧入路异形钢板固定治疗Barton骨折的效果。方法15例Barton骨折采用掌侧入路异形钢板固定。15例桡腕关节均脱位,骨折块位于掌侧10例,背侧5例,其中5例行自体植骨。结果术后随访6个月~3a,平均17.8个月。按Deoliveiva标准,优11例,良3例,可1例。结论经掌侧入路异形钢板固定,手术创伤小,符合解剖学特点,固定牢靠,有利于早期功能锻炼。     

掌侧锁定接骨板内固定治疗桡骨远端掌侧Barton骨折的疗效分析

目的探讨掌侧锁定接骨板内固定治疗桡骨远端掌侧Barton骨折的临床疗效。方法回顾性分析自2017-01—2020-01采用掌侧锁定接骨板内固定治疗的50例桡骨远端掌侧Barton骨折,比较术前、术后1个月、术后1年GartlandWedey功能评分及疼痛VAS评分。结果 50例均顺利完成手术并获得完整随访,随访时间6~20个月,平均12.8个月。50例均获得骨性愈合,骨折愈合时间2~3个月,平均2.6个月。术后1个月及术后1年Gartland-Werley功能评分及疼痛VAS评分较术前明显改善,差异有统计学意义(P<0.05)。末次随访时复查X线片显示固定效果满意,未出现血管、神经损伤,切口均一期愈合;桡骨远端掌倾角平均12.56°,尺偏角平均18.36°,背伸平均62.86°,掌屈平均60.25°,桡偏平均22.32°,尺偏平均26.56°,旋前平均86.23°,旋后平均83.78°;采用Gartland-Wedey功能评分评价疗效:优30例,良16例,可4例,优良率92%。结论熟悉桡骨远端掌侧Barton骨折的形态学,合理使用掌侧锁定接骨板内固定治疗桡骨远端掌侧Barton骨折的疗效可获得满意的临床疗效。     

T型钢板内固定治疗Barton骨折

目的分析手术复位T型钢板内固定治疗Barton骨折的临床疗效。方法自1998年6月起，对18例Barton骨折，其中掌侧型15例，背侧型3例，均采用手术复位T型钢板内固定治疗。结果本组18例均获随访，随访时间为12～38个月，平均21．2个月，骨折全部愈合，腕关节功能按改良Mcbride评分和纽约骨科医院腕关节评估标准评定，优10例，良6例，可1例，差1例，优良率为88．9％。结论手术复位T型钢板内固定是治疗Barton骨折理想有效方法。     

后外侧入路桡骨远端掌侧钢板内固定在三踝骨折治疗中的应用

目的探讨采用后外侧入路桡骨远端掌侧钢板内固定治疗三踝骨折的临床疗效。方法回顾性分析自2012-03—2016-01经后外侧入路桡骨远端掌侧钢板内固定治疗的27例三踝骨折。先取侧俯卧位,将外踝骨折复位后予以解剖钢板或重建钢板固定,再从腓骨短肌及拇长屈肌间隙钝性分离显露后踝骨折断端,复位后用桡骨远端掌侧钢板固定。再取仰卧位,根据内踝骨折的位置作踝关节前内侧或后内侧弧形切口,复位骨折后用拉力螺钉固定内踝骨折。结果 27例均获得随访,随访时间平均14(12~36)个月。骨折全部愈合,愈合时间平均14(12~17)周。术后1年疗效根据BairdJackson踝关节评分系统评定:优22例,良3例,可2例,优良率92.6%。结论后外侧入路桡骨远端掌侧钢板内固定治疗三踝骨折能清楚显露后踝骨折断端,骨折复位满意,固定可靠,有利于术后早期功能锻炼促进踝关节功能恢复。     

后外侧入路桡骨远端掌侧T形钢板治疗后踝骨折

目的探讨后外侧入路桡骨远端掌侧T形钢板治疗后踝骨折的临床疗效。方法对31例后踝骨折患者(33足)行踝关节后外侧入路切开复位内固定外踝、复位后踝后,用桡骨远端掌侧T形钢板固定后踝骨折,再仰卧位复位固定内踝。结果 28例获得随访,时间12～24个月,3例失访。获得随访患者骨折均一期骨性愈合,愈合时间3～5个月。随访未发现骨折再移位、畸形愈合、内固定物松动及断裂等并发症。术后1年根据Baird-Jackson踝关节评分系统评定疗效:优24例,良3例,可1例,优良率为27/28。结论经后外侧入路桡骨远端掌侧T形钢板切开复位内固定治疗后踝骨折,显露清楚,固定牢靠,临床效果满意。     

Bilateral volar lunate dislocation

A 12 years follow-up of a case of bilateral volar lunate dislocation treated by open reduction and K-wire stabilisation of both wrists six days after injury is described. Despite aseptic necrosis of both lunates, the patient is pain free and has useful function, without the development of lunate ischaemia and collapse, carpal instability or posttraumatic osteoarthritis.     

Multiple carpometacarpal volar dislocation

A case of multiple carpometacarpal joints volar dislocation in a young man of 25 years of age is reported. He presented with pain and deformity of his left hand immediately after road traffic accident. He was unable to move his left hand. X-rays of the affected hand showed volar dislocation of all four medial carpometacarpal joints. Dislocated joints were reduced, fixed with K-wires and immobilized in slab. K-wires were removed after 8 weeks. Hand function is satisfactory on the follow-up.     

Arthroscopic volar wrist ganglionectomy

As an original technique developed by our department, the preliminary result of arthroscopic resection of volar wrist ganglion was first published in 2003. Since then, there were few reports in the literature concerning this new treatment method. The aim of the study is to evaluate the long-term outcome of this treatment technique. From August 1997 to April 2005, 21 volar wrist ganglia with average size of 2 cm (range 1-4 cm) were treated. The average age of patients was 48.6 (range 18-63). Thirteen ganglia had previous treatment including either aspiration or open excision. Seventy-one percent of the operations were performed under local anesthesia. Wrist arthrogram was performed in 9 cases. Seven cases showed origin from radiocarpal joint and all proceeded to arthroscopic resection successfully. Arthroscopically, 75% of ganglia arose from the interval between radioscaphocapitate and long radiolunate ligament, and 25% from the interval between long radiolunate and short radiolunate ligament. Sixteen of the 21 ganglia could be excised by arthroscopic technique. The average follow up was 56 months (range 9-101 months). There were 2 recurrences. One was treated with repeated arthroscopic excision and the other by open excision. There was no impairment of wrist motion and function in all patients. No neurovascular complication was encountered. Arthroscopic resection was an effective treatment method for well-selected volar wrist ganglion arising from the radiocarpal joint in long run.     

Transverse volar skin laceration of the finger: Sign of volar plate injury.

Transverse tears of the volar skin of a finger with a hyper-extension injury is associated with frequent volar plate tears or avulsions. Recognition is essential for surgical exploration of the volar plate and supporting joint structures and, if injured, surgical repair should be carried out at the time of skin suturing.     

The volar carpal ligament.

The volar carpal ligament, or superficial part of the flexor retinaculum, is described. A triangular area is identified on the ulnar side of the flexor retinaculum.     

Arthroscopic assessment of the volar region of the scapholunate interosseous ligament through a volar portal

PURPOSE: The volar region of the scapholunate interosseous ligament is one of the key structures that maintains scapholunate alignment. It is, however, difficult to evaluate this ligament using standard diagnostic procedures, including the arthroscopy through a dorsal portal. We have performed arthroscopic evaluation of this ligament through a volar portal. METHODS: Skin incision was made at just radial of the flexor carpi radialis tendon and the portal was opened through the tendon sheath. RESULTS: The volar approach enabled us to directly observe the extent of the tear of the volar region of scapholunate interosseous ligament. A shaver is inserted through the dorsal portal, and debridement can be performed by using the volar portal vein. We have not had any complications using volar portal. CONCLUSION: Volar approach is a feasible and safe procedure to evaluate and treat the volar region of the scapholunate interosseous ligament.     

The volar portal in wrist arthroscopy

Wrist arthroscopy is not only a diagnostic tool; it has also developed into a valuable treatment alternative for several wrist disorders. All of the standard portals are dorsally located, leaving the dorsal sector of the radiocarpal and midcarpal joint partially invisible. A volar portal has been developed through the bed of the flexor carpi radialis tendon, thus expanding the therapeutic possibilities. We report our personal experience with the use of a volar portal in 28 of 206 (14%) wrist arthroscopies. No technical problems or neurovascular complications were encountered. We think the standardized approach as described is valuable and safe.